Are Growing Pains in Children Real?

Two muscle and joint problems linked to growth spurts

Doctor talking to patient in examination room
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Growing pains is not only a term that applies to the emotional challenges of childhood but to the physical ones, as well. Boys and girls between the ages of nine and 14 will commonly complain of muscle and joint pains directly associated with pubescent growth spurts.

The term "growing pain" doesn't suggest a particular diagnosis but is rather used to describe the general symptoms of musculoskeletal pain seen exclusively in adolescence.

Two such conditions are commonly associated with this:

Apophysitis

One of the most common causes of growing pains in children is a condition known as apophysitis. In pediatrics, it refers to the inflammation of growth cartilage found in children which serves as the attachment site for muscles and tendons. Apophysitis can also develop in athletes due to the repetitive pulling of muscle at the bone attachment site.

While apophysitis can develop in children due to the same types of repetitive stress, it is more often associated with growth itself.

During puberty, the rapid growth of bone often exceeds the ability of the muscle-tendon unit to stretch sufficiently. This increases tension at the attachment site and triggers an inflammatory response, including localized swelling, pain, and tenderness. In young athletes, training and competition further add to the stress.

Symptoms of apophysitis typically worsen with sports and can continue well into the night, interfering with sleep.

The pain and swelling typically improve with rest, ice application, and non-steroidal anti-inflammatory drugs like Advil (ibuprofen) or Aleve (naproxen). The restriction of movement is sometimes needed, including the use of an orthopedic knee brace or shoe insert.

Delayed Onset Muscle Soreness (DOMS)

Another commonly described cause of growing pains is delayed onset muscle soreness (DOMS), a condition which also affects adults.

Children will DOMS will typically complain of pain in both legs, most specifically the thighs and/or calves. The symptoms can range from pain and stiffness to severe cramping and almost always occur within hours of a sporting or athletic event. Symptoms in children don't typically persist for more than several hours and usually resolve by the morning.

DOMS differ in adults in that the symptoms will more often appear 24 to 74 hours after exercise and take up to seven days to fully resolve.

In children, DOMS is related to eccentric (lengthening) contractions of the legs. If experiencing a pediatric growth spurt, the muscle tension may already be high due to the expanded length of the fibula and tibia (calf bones) and femur (thigh bone).

Treatment of DOMS in children is similar to that for apophysitis. Limiting sports activity, especially the intensity and duration of a sport, may be necessary if symptoms persist or worsen.

Sources:&

Santos, R.; Rossi, R.; and Rosa, E. "Perception of Delayed Onset Muscle Soreness in Children and Adults Trained, Submitted to a Training Session of Force Eccentric." Int J Sports Sci. 2016; 6(2):23-6. DOI: 10.5923/j.sports.20160602.01.

Wilson, J. and Rodenberg, R. "Apophysitis of the lower extremities." Contemporary Pediatrics. 2011; 12(1):342-90.

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